Psychic Trauma & Children’s Mental Health

1. Psychic Trauma& Children’s Mental Health Robert L. Johnson, MD, FAAP Professor and Chair of Pediatrics Professor of Psychiatry Director of Adolescent and Young Adult Medicine Keith Bratcher Administrative Aide

3. Psychic Trauma • Experience that is emotionally painful, distressful, or shocking, which often results in lasting mental and physical effects. • A normal response to an extreme event. • Involves the creation of emotional memories about the distressful event that are stored in structures deep within the brain.

4. Psychic Trauma • In general, it is believed that the more direct the exposure to the traumatic event, the higher the risk for emotional harm. • But even second-hand exposure to violence can be traumatic.

5. Traumatic events • Violence • personal assaults such as rape or mugging • exposure to violence in the home or on the streets can lead to emotional harm • directly or indirectly witnessing or experiencing a violent or catastrophic event • Natural or human-caused disasters • Accidents • Military combat

6. Reactions to Psychic Trauma • Some suffer only worries and bad memories that fade with emotional support and the passage of time. • Others are more deeply affected and experience long-term problems.

7. Reactions to Psychic Trauma:Children And Adolescents • Children 5 years of age and younger: • Fear of being separated from the parent • Crying • Whimpering • Screaming • Immobility and/or aimless motion • Trembling • Frightened facial expressions and excessive clinging.

8. Reactions to Psychic Trauma:Children And Adolescents • Children 5 years of age and younger: • Returning to behaviors exhibited at earlier ages (these are called regressive behaviors), such as thumb-sucking, bedwetting, and fear of darkness. • Children in this age bracket tend to be strongly affected by the parents' reactions to the traumatic event.

9. Reactions to Psychic Trauma:Children And Adolescents • Children 6 to 11 years old : • extreme withdrawal • disruptive behavior • inability to pay attention • regressive behaviors, nightmares, sleep problems, irrational fears • irritability • refusal to attend school or poor school performance • outbursts of anger and fighting

10. Reactions to Psychic Trauma:Children And Adolescents • Children 6 to 11 years old : • Stomach aches • Somatic symptoms that have no medical basis • Depression • Anxiety • Feelings of guilt • Emotional numbing or "flatness"

11. Reactions to Psychic Trauma:Children And Adolescents • Adolescents 12 to 17 years old: • Responses similar to those of adults • ATOD abuse • Problems with peers • Anti-social behavior • Withdrawal and isolation • Physical complaints • Suicidal thoughts • School avoidance, academic decline

12. Reactions to Psychic Trauma:Children And Adolescents • Adolescents 12 to 17 years old: • Feelings of extreme guilt over his or her failure to prevent injury or loss of life • Revenge fantasies that interfere with recovery from the trauma.

14. Post-traumatic stress disorder (PTSD) • An anxiety disorder • Exposure to a terrifying event or ordeal • Grave physical harm occurred or was threatened

15. Prevalence of PTSD • 3.6 percent of U.S. adults ages 18 to 54 (5.2 million people) have PTSD during the course of a given year. • Rates of PTSD identified in child and adult survivors of violence and disasters vary widely. • 2% after a natural disaster (tornado) • 28% after an episode of terrorism • 29% after a plane crash

16. Symptoms of PTSD • Symptoms last more than 1 month • Repeatedly re-experience the ordeal in the form of • Flashback episodes • Memories • Nightmares • Frightening thoughts

17. Symptoms of PTSD • Emotional numbness • Sleep disturbances • Depression • Anxiety, irritability • Outbursts of anger • Feelings of intense guilt • Poor concentration • Startle reaction • Regressive behavior

18. Symptoms of PTSD • Symptoms worsened by exposure to events (anniversaries) or objects reminiscent of the trauma. • Routine avoidance of reminders of the event or a general lack of responsiveness (e.g., diminished interests or a sense of having a foreshortened future).

19. When Does PTSD First Occur? • PTSD can develop at any age, including in childhood. • Symptoms typically begin within 3 months of a traumatic event, although occasionally they do not begin until years later. • Once PTSD occurs, the severity and duration of the illness varies. Some people recover within 6 months, while others suffer much longer.

20. Co -morbidities • Depression • Alcohol or other substance abuse • Anxiety disorder • Headaches • Gastrointestinal complaints • Immune system problems • Dizziness • Chest pain • Discomfort in other parts of the body

21. Predilections • Characteristics of the trauma exposure • Proximity to trauma • Severity • Duration

22. Predilections • Characteristics of the individual • Prior trauma exposures • Childhood abuse • Family history/prior mental illness • Gender • Family support

23. Predilections • Post-trauma factors • Availability of social support • Emergence of avoidance/numbing • Hyperarousal • Re-experiencing symptoms

24. Treatment • Trauma/grief-focused psychotherapy • cognitive-behavioral therapy • group therapy • exposure therapy • Medications • Counseling soon after a catastrophic event